10060107CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10870 N STELLING RD BLDG 42 A-D I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 10060107
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OWNER'S NAME: VILLA SERRA APTS A CA LMTD PRTNRSHP 1608 4TH ST STE 120 DATE ISSUED: 06/17/2010
OWNER'S PHONE: 6509313457 BERKELEY, CA 94710 PHONE NO: (510) 525-9378
❑ LICENSED CONTRACTOR'S DECLARATION r- r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
MECH � RESH)ENTIAL r COMMERCIAL
Contractor
Date
I hereby affirm that I am licensed corder the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code). ® "
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.---
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APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep tatmI ss the City of Cupertino against liabilities, judgments,
costs, and expenses Which may accrue against said City inconsequence of the
granting of this per 'it. dditionally, the applicant understands and will comply
with all non-po nt s �1rr e egulations per the Cupertino Municipal Code, Section
9.18. >>``
Signature Date q),
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JOB DESCRIPTION: CONSTRUCT NEW MULTI -FAMILY BUILDING
Sq. Ft Floor Area: Valuation: $400000
APN Number: 32609056.42A-D I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b
Dater
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements order Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants s defined by tire Bay Area Air Quality Management District I will
maintain co p i nce with the Cupertino Municipal Code, Chapter 9.12 and tire
Health & Sa a ode, Sections 25505, 25533, and J25534.
Owner t ri d agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Addres
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional